The ileocaecal knot

Ileocecal knotting as a rare cause of small bowel obstruction: a case report

Introduction

Ileocecal knot syndrome, a rare cause of small bowel obstruction where the ileum wraps around the cecum, poses a significant challenge for preoperative diagnosis. Prompt intervention is crucial due to the risk of rapid bowel deterioration and increased mortality.

Case presentation

A 45-year-old female presented with central abdominal pain associated with vomiting, abdominal distension, and obstipation. On examination, she was ill-looking with hypotension, tachycardia with a feeble pulse, direct and rebound abdominal tenderness, and absent bowel sounds. Aggressive fluid resuscitation was done. Based on the clinical presentation and abdominal radiograph suggestive of intestinal obstruction, an emergency exploratory laparotomy was done, which showed an ileocecal knot and 130 cm of gangrenous ileum. Peritoneal lavage followed by resection of non-viable ileum with double barrel ileostomy was done.

Discussion

Ileosigmoid, appendico-ileal, ileoileal, and ileocecal knotting are the various types of intestinal knotting, with very few cases of ileocecal knotting being reported. Intestinal knotting causes severe bowel obstruction, resulting in reduced mucosal perfusion, progressive ischemia, and peritonitis, leading to high mortality. X-ray findings of multiple air-fluid levels are non-specific, and for definitive diagnosis, laparotomy is required. Assessing bowel viability before definitive surgery is essential. Despite positive outcomes, extensive resection can lead to malabsorption and ileus, with potential risk for developing short bowel syndrome.

Conclusion

Despite its rarity, the possibility of ileocecal knotting should be considered in cases of small bowel obstruction due to its potential for rapid deterioration. Prompt resuscitation followed by emergency laparotomy is necessary to prevent mortality.

Ileocecal Knotting Causing Intestinal Obstruction on Early Postpartum Period: Case Report

Introduction

Intestinal knotting syndromes are rare causes of mechanical bowel obstruction, ileo-sigmoid knotting being the most common type. Ileocecal knotting is the rarest type among knot syndromes and there are few case reports across the world.

Case Presentation

We present a case of ileocecal knotting in a postpartum patient with abdominal distention, vomiting and failure to pass feces and flatus. Plain abdominal radiograph revealed dilated small bowel loops with multiple air fluid levels. Exploratory laparotomy was performed with intra-operative finding of ileocecal knotting with viable bowel, mobile cecum and ascending colon and gangrenous tip of appendix. We untied the knot and performed an appendectomy. Due to intra-operative instability of the patient's vital signs, right hemicolectomy was differed and cecum as well as ascending colon were fixed to right posterolateral abdominal wall.

Clinical Discussion

Ileocecal knotting is a very rare finding, and few case reports have been published. The intra-operative findings of the mobile cecum and ascending colon are consistent with previous reports and it is a predisposing factor for knot besides low BMI and young age of our patient. Surgical management is dictated by intra-operative conditions such as viability of the bowel, intra-operative stability of the patient, extent of resection and length of the remaining bowel. Surgical options include en bloc resection of knot with gangrenous bowel and end to end anastomosis or end ileostomy with closure of distal end.

Conclusion

Ileocecal knotting should be considered as a differential diagnosis for patients presenting with intestinal obstruction with unusual radiographic findings. Early diagnosis and prompt surgical intervention prevents bowel infarction and enhance the prognosis. Preoperative abdominal CT scan is helpful in such cases with unusual radiographic findings.

Ileocecal knotting in a young man: A very rare and unique cause of intestinal obstruction

Ileocecal knitting should be considered as a differential diagnosis of small intestinal obstruction. Aggressive resuscitation and early surgery will be life-saving. One should anticipate finding extensive bowel gangrene which requires aggressive resection.